Trends in smoking, cancer risk, and cigarette promotion. Current priorities for reducing tobacco exposure.

Tobacco use in the US is currently responsible for more than 30% of all cancer deaths, including cancers of the lung, larynx, oral cavity, pharynx, pancreas, kidney, bladder, and cervix. The lung cancer epidemic in men and then women since the turn of the century followed an increased prevalence of cigarette smoking. Recent declines in lung cancer rates in men reflect a decline in men's smoking prevalence over the past few decades. However, lung cancer is still the major cause of cancer death in men and is now essentially tied with breast cancer as the leading cause of cancer death in women. The demography of smoking has markedly altered over time, so that current efforts to prevent tobacco use should address young women, ethnic minorities, lower socioeconomic groups, and Third World populations. The tobacco industry's aggressive strategies to promote tobacco use should also be monitored, publicized, and countered. Relevant activities for the individual health-care practitioner are suggested here. Because more than 25% of Americans are still smoking, our priority in cancer prevention must be to continually encourage the reduction of tobacco use.